Researchers Link ICD-10 Shift to Financial Losses

John Commins, for HealthLeaders Media , March 17, 2014

Venepalli: Come October every single report that your hospital is going to generate is going to be under a different set of codes. What are they going to do when they have to compare how that hospital is doing to last year or the year before? They are comparing apples and oranges in some situations.

How do you know? How can you explain your numbers going down or up? How can you use your numbers to predict who you hire or how you should be expanding? This is really relevant for what is happening with (accountable care organizations) and how to you base purchasing. That secondary level of analyses once you are using 1CD-10 may even become more important as a tool to look back at, at least for the first five or six years.

HLM: How can providers best prepare for the transition?

Venepalli: Take your 100 most-frequent billing codes, inpatient and outpatient, and also look at the hundreds you are getting the most reimbursements for and run it through this analysis. What you will find is that the majority of the codes you are OK with and that 18% to 20% of codes are convoluted and maybe incorrect.

This is so easy to do you can do it in an afternoon. Run these codes and wherever you are seeing that the ICD-10 codes are not making sense, or there is some sort of information loss, train your coders, train your billers and physicians to recognize and anticipate that.

Boyd: We have a limited time before the transition and every clinic has a different amount of time to invest in this. If you have 100 codes and it is somewhere between 15 and 20 of codes that are convoluted and you only have a few hours to spend with your staff those are the one you focus on. We are trying to triage the training. You can't spend 100 hours between now and October to train all of the physicians and staff.

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2 comments on "Researchers Link ICD-10 Shift to Financial Losses"

Dan Toren (3/18/2014 at 2:32 PM)
Great questions Susie. From 3M website:"How 3M became the ICD-10 leader Under contract with the Centers for Medicare and Medicaid Services (CMS), 3M designed and developed the ICD-10 Procedure Coding System (ICD-10 PCS) and the General Equivalence Mappings (GEMs). 3M also completed the initial conversion of the CMS MS-DRGs to ICD-10." Disclaimer: we have nothing to do with 3M. However, anticipating the angst of October 1st, we've developed and recently released an app that may help alleviate the anxiety related to the ICD-10 implementation - ICD10Doc. And yes, we have actually used GEM for mapping between ICD-9 and ICD-10. is intended especially for the small practices that don't have the support or budgets of a hospital HIM department. You can check it out at Your feedback would be much appreciated Thanks Dan

Susie/Internal Medicine Practice Administrator (3/17/2014 at 10:54 AM)
I am still trying to figure out why there is the switch to ICD-10 in the first place. Real facts, not just government or insurance company public statements. Who wrote/created the GEMs? Is this evidence based medicine? When the author states that the maps may be wrong, most practices simply don't have the time or knowledge to create new algorithms. Is this tool for oncology only? Is this "map" ubiquitously used by Medicare and Commercial insurance companies? In other words, are they sharing the same GEMs? Any assistance would be greatly appreciated. Thank you in advance.




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